Medical Economics Consultant

Highmark Health; Bristol (RI); On-site; USD 114,000 - 140,000; Full time

Job summary

Highmark Health is seeking a results-oriented professional to transform medical cost data into strategic insights that guide cost-management decisions. You will partner with matrix teams to develop analytics, track program outcomes and highlight opportunities for value realization.

You will extract and analyze large datasets using SAS, SQL and related tools, producing concise, executive-ready presentations for business partners and leadership.

Qualifications

• Bachelor's Degree in Business, Health, Economics, Mathematics/Actuarial Sciences or other related area.
• Master's Degree in Business, Health, Economics, Mathematics/Actuarial Sciences or other related area.
• 5 years of Medical Economics, Healthcare Analytics, Informatics and/or Actuarial Services in the health care payer sector.
• Strong coding background (R, R Shiny, Python, SQL, etc.). Experience building dashboards in Tableau, Power BI, or R Shiny.
• Strong Technical Data Skills (SAS / SQL, R, Tableau, Excel, etc.)
• Experience in the healthcare Industry, with solid knowledge of emerging trends and challenges
• Languages (Other then English)
• Travel Required
• Office-Based
• Travel regularly from the office to various work sites or from site-to-site
• Works primarily out-of-the office selling products/services (sales employees)
• Physical work site required
• It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job.
• Compliance Requirement: This position adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies.
• As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company’s Handbook of Privacy Policies and Practices and Information Security Policy. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements.

Responsibilities

• Use medical cost analytics to provide strategic insights into cost trends for decision support.
• Develop value propositions, track outcomes, and identify opportunities for cost programs.
• Extract, summarize and analyze large datasets using SAS, SQL or similar tools.
• Present analytics results to key business partners with clear, executive-level communication.
• Create dashboards in Tableau, Power BI or R Shiny.

Skills

Data analytics

Executive communication

Healthcare analytics

Education

Bachelor's degree

Master's degree

Tools

R

R Shiny

Python

SQL

Tableau

Power BI

Job description

This job is responsible for using medical cost analytics to provide fact based strategic insights into emerging medical cost trends. Using large sets of data, the ideal candidate will create the story of medical cost trends in a way that is clear, concise and easily understandable. More specifically, will engage with matrix partners to develop the medical cost analytics to determine the value of business solutions. Using data driven analytics, the ideal candidate will: 1) develop the value of the programs, 2) track the outcomes of the programs, and 3) provide strategic insight into areas of focus/opportunities.

Provide strategic/tactical insights into emerging medical cost trends. Proficiency to extract, summarize and analyze large datasets via SAS, SQL or other similar tools. Provide business areas with opportunity assessments of their strategic medical cost programs. Coordinate savings opportunity projections and post implementation savings measurements. Leverage analytical experience and knowledge to drive independent medical cost analytics; develop areas of opportunity using a fact-based analysis, present medical cost analytics and insight into claim cost drivers to key business partners.

Strong communication skills (verbal and executive quality presentations) to present clear, concise presentations of the detailed analytics.

Bachelor's Degree in Business, Health, Economics, Mathematics/Actuarial Sciences or other related area

Master's Degree in Business, Health, Economics, Mathematics/Actuarial Sciences or other related area

5 years of Medical Economics, Healthcare Analytics, Informatics and/or Actuarial Services in the health care payer sector

Strong coding background (R, R Shiny, Python, SQL, etc.). Experience building dashboards in Tableau, Power BI, or R Shiny.

Strong Technical Data Skills (SAS / SQL, R, Tableau, Excel, etc.)

Experience in the healthcare Industry, with solid knowledge of emerging trends and challenges

Languages (Other then English)

Travel Required

Office-Based

Travel regularly from the office to various work sites or from site-to-site

Works primarily out-of-the office selling products/services (sales employees)

Physical work site required

It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job.

Compliance Requirement: This position adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies.

As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company’s Handbook of Privacy Policies and Practices and Information Security Policy. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements.

127,100.00 Base pay is determined by a variety of factors including a candidate’s qualifications, experience, and expected contributions, as well as internal peer equity, market, and business considerations. Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against all individuals based on any category protected by applicable federal, state, or local law.